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Upper Extremity MSDs Computer Workstations
Rosemarie A. Trigger, PT, CSHEPhysical Therapist, Certified Specialist in Health ErgonomicsPhysical Therapy Associates of Schenectady, P.C.
Upper Extremity MSDs
Carpal tunnel syndrome*Tendonitis*Bursitis*Tenosynovitis*Dequervain’s syndrome*Trigger finger*Epicondylitis– Tennis elbow– Golfer’s elbow
Rotator cuff syndromeThoracic outlet syndrome*Hand arm vibration syndromeSprains and strains– Sprain – injury to
ligamentous structure– Strain – injury to muscle or
tendon* Along with back and neck pain, most common MSDs seen in office/computer workers
Postural Risk Factors
Extreme ROM posturesExtreme ROM postures– Close to end range– Require active and passive
stress forces– May exert compressive forces
on blood vessels
Static holdingStatic holding– Overloads joints against
gravity– Blood flow compromised –
can’t get in for nutrition or bring waste products out
Awkward posturesAwkward postures– Outside of neutral– Less efficient, fatigue easier– Muscles can create less force– Increases wear and tear on
sensitive structures like tendons, nerves, joints
Neutral upper extremity postures
Neutral wrist postures align forearm with the wrist and hand.
Resting position for joints – least amount of biomechanical strain.
ELBOW PAIN? Wrist and hand positions may be the real cause!!
• Muscles attached on the bone on the outside of your elbow extend wrist and fingers, as well as turn your palm to facing up position
• Muscles attached on the bone on the inside of your elbow bend wrist and fingers, as well as turn your palm to facing down position
• Problems may be related to:– Repetitive wrist
and hand motions– Forceful gripping– Working in other
than neutral positions
Rotator Cuff Muscles…
…not only rotate your shoulder, but provide stability for all upper body activities!
Strengthen your rotator cuff to reduce shoulder injuries!
Reduce stress on carpal tunnelStretch frequentlyAlways work in neutral – keep wrists straightMaintain circulation – open/close hand, shake hands out, ROMInterrupt repetitious activitiesAllow adequate recovery time from repetition or forceful exertionAvoid activities that require excessive side to side or up and down movementAvoid pressure over forearm or heel of handMouse with open, relaxed hand
Posture and work tips
Ergonomists agreeErgonomists agree……All work activities should permit the worker to adopt several different, but equally healthy and safe postures.
Where muscular force has to be exerted it should be done by the largest appropriate muscle groups available.
Work activities should be performed with the joints at about mid-point of their range of movement. This applies particularly to the spine, trunk, and upper limbs.
Correct Sitting Posture
Sit in a straight back chairHips and buttocks touching the back of the chairFeet flat on floorGently roll the pelvis forward by creating a comfortable arch in the small of the backUse a rolled towel or lumbar roll in the small of the backSimultaneously, lift the chest, head above shoulders maintain upright sitting positionChin is parallel to floor
Anterior vs. Posterior Pelvic Tilt
Find your normal curve
Normal lumbar curve is in between a flat or rounded back position and excessive anterior tilt
Neutral Posture
3 curves in back should always be maintained…
– Standing– Sitting – Working – Sleeping– Playing
Adjust the chair first!
Adjust controls from a seated positionAdjust height so feet are supported on floor or footrestAdjust lumbar support and back tilt to promote neutral spine postureAdjust elbow height with arms relaxed next to trunk
Forearm are approx. 70-90° angle to upper armsSeat tilt lower in front of chair yields higher hips and back tiltKnees higher yields reclined position for back rest/reading materialsUse both to vary posture and different work tasks
Office chair wish list…
Lumbar back support or contour Waterfall seat designStable five-point baseWheels or casters suitable to type of flooringArmrests designed to support arms, shoulders, neck (adjustable)Adjustable seat height, and tilt mechanismAdequate width and adjustable depthNo pressure behind knees Swivel reduces trunk twistingDurability and adequate weight limits
Active vs. Passive Adjustability
Loads on spine are twice as high in flexed forward sitting as upright unsupported sittingTheoryTheory - passive ergo chairs are designed to continually adapt to the user to allow more natural changes in position – provides continual support as well
Not moving is harmful!Computer work diminishes opportunity to change posturesStatic and constrained postures interrupt blood flowFixed postures are as likely to lead to back pain as heavy laborLack of movement is associated with leg swelling
Keyboard and Mouse
Basic components:
–– POSITIONPOSITION – directly in front of trunk, elbows close to body, forearms parallel to floor; if necessary use articulating keyboard/mouse platform
–– HEIGHTHEIGHT – relative to sitting posture, chair and monitor
–– DISTANCEDISTANCE – keyboard platform ~ above thighs; mouse in same plane as keyboard or closer
Maintain neutral wrist posture
Wrists remain straight and floatfloat over keyboardPalms rest when notnottyping or mousingAvoid deviating wrists to right or leftConsider using a negative slope on your keyboard
Stretch Break…
Change position often to reduce stress and fatigueMove to maintain and improve circulation to musculoskeletal tissuesWarm-up and stretch to minimize discomfort and reduce risk of overuse problemsAt minimum rest 5 min per hour if repetitive typing
Monitor
Top line of text is slightly below eye level while seated15-60° viewing angleDistance eyes to screen at least arms lengthMonitor too close or too far may contribute to poor posture
Lighting and Glare
Inappropriate lighting for computer work may lead to eyestrain, headaches
or blurred vision.
•Light source should be parallel to your line of vision
•Never position desk directly in front of a window
•Monitors placed 90° to window reduce glare and reflection
•Close blinds to reduce direct light
•Clean monitor screen at least once per week
•Try task lighting
•Dark characters on light background less effected by reflection
•If florescent lighting is too bright, remove one bulb
•Eye exercises help!
Rearrange the work area…
Avoid reachingKeep most used objects closestAvoid twisting any body partIncline documents or use document holder Speaker or headsets for frequent phone use
Individual worker responsibilities…
Adapt job duties to abilities– Rotate job tasks to allow adequate recovery time
Adjust your work environment– Work at appropriate heights– Support body parts as necessary
Change your work habits– Warm up for work– Avoid awkward or prolonged postures, move frequently– Lift safely and use neutral postures
Exercise and stay healthy– Maintains strength, flexibility and cardiovascular status
Resources
GE Workstation Evaluation:
http://ehs.corporate.ge.com/fileDownload.jsp?docID=11843
GE EHS/Ergonomics Website
Workstation evaluation checklist:
http://www.osha.gov/SLTC/etools/computerworkstations/checklist.html
OSHA etools – computer workstations, workstation checklist, purchasing guide checklist – www.osha.gov
CU Ergo – Cornell University Ergonomics Web
http://ergo.human.cornell.edu/CUVDTChecklist.html
Contact us…
Rosemarie Trigger, PT, CSHEPhysical Therapy Associates
Phone: 518-887-2533
Visit our Physical Therapy Associates website at:
www.physicaltherapyschdy.com